Introduction: 

Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery.

Methods: 

Seventy-six patients undergoing spinal surgery were randomly allocated into sugammadex and control groups. In the sugammadex group, a rocuronium infusion was titrated to maintain moderate neuromuscular blockade (2 twitches on train-of-four) until dural opening when the rocuronium infusion was discontinued and 2 mg/kg sugammadex administered. In the control group, no neuromuscular blockade was administered after induction of anesthesia. The primary outcome was a comparison between sugammadex and control groups of mean TceMEP amplitudes in the abductor pollicis brevis muscles of both upper extremities 5 minutes after dural. Secondary outcomes included TceMEP amplitudes at 10, 20, 30, and 60 minutes after dural opening.

Results: 

Sixty-six patients were included in the analysis. TceMEP amplitudes were significantly greater in the sugammadex group (629 μV, interquartile range: 987 μV) than in the control group (502 μV, interquartile range: 577 μV; P=0.033) at 5 minutes after dural opening. TceMEP amplitudes were also greater in the sugammadex group at 10 minutes (P=0.0010), 20 minutes (P=0.003), 30 minutes (P=0.001), and 60 minutes (P=0.003) after dural opening.

Conclusions: 

Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.

中文翻译：

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舒更葡糖在脊柱手术中经颅电动诱发电位监测中的作用：随机对照试验

介绍： 

神经肌肉阻滞可抑制经颅电动诱发电位 (TceMEP) 振幅，通常在 TceMEP 监测期间避免使用。在这项随机对照试验中，我们研究了在接受脊柱手术的患者中，舒更葡糖是否可以逆转罗库溴铵诱导的 TceMEP 振幅抑制。

方法： 

76 名接受脊柱手术的患者被随机分为舒更葡糖组和对照组。在舒更葡糖组中，滴定罗库溴铵输注量以维持中度神经肌肉阻滞（每四次抽搐 2 次）直至硬脑膜打开，此时停止罗库溴铵输注并给予 2 mg/kg 舒更葡糖。在对照组中，麻醉诱导后不进行神经肌肉阻滞。主要结果是比较舒更葡糖和对照组硬脑膜植入后 5 分钟双上肢拇短展肌的平均 TceMEP 振幅。次要结果包括硬脑膜打开后 10、20、30 和 60 分钟的 TceMEP 振幅。

结果： 

分析中包括 66 名患者。硬脑膜打开后 5 分钟，舒更葡糖组的 TceMEP 振幅（629 μV，四分位距：987 μV）显着大于对照组（502 μV，四分位距：577 μV；P =0.033）。硬脑膜打开后10 分钟（ P = 0.0010）、20 分钟（P = 0.003）、30 分钟（P = 0.001）和 60 分钟（P = 0.003）时，舒更葡糖组的 TceMEP 振幅也更大。

结论： 

持续输注罗库溴铵引起的中度神经肌肉阻滞可被舒更葡糖有效逆转。这表明舒更葡糖可用于在需要肌肉放松的脊柱手术期间增强 TceMEP 波形监测。